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Short Bowel Syndrome: Physiologic Considerations and Nutritional Management

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Nutritional Management of Inflammatory Bowel Diseases

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Abstract

Short bowel syndrome (SBS) refers to a malabsorptive state resulting from loss of intestinal structure and/or function due to congenitally absent, extensively resected, and/or diseased bowel. SBS is typically defined by the presence of <200 cm of functional small intestine, and its management can be divided into phases, some or all of which may require the provision of parenteral nutrition and/or intravenous fluid support to maintain adequate nutrition and hydration. The condition is linked with multiple complications, high utilization of healthcare resources, reduced quality of life, and significant morbidity and mortality. Clinical implications of SBS are influenced by the extent and location of resected bowel, viable length and absorptive capacity of remnant bowel, and small intestinal continuity with the colon. Primary management objectives in SBS include establishing adequate fluid and electrolyte balance, promoting intestinal adaptation, and providing adequate hydration and nutritional (macro- and micro-nutrient) support. Pharmacotherapeutic optimization with frequent reassessments over time can mitigate clinical consequences and maximize intestinal rehabilitation potential. A multidisciplinary approach, involving nutritional, pharmacotherapeutic, psychological, and surgical facets, is paramount in SBS. Healthcare goals include restoring nutritional autonomy, preventing complications, and enhancing quality of life. This chapter addresses the etiology, epidemiology, relevant anatomy and pathophysiology, clinical manifestations, and potential complications of SBS. Hydration and nutritional (macro- and micro-nutrient) management, along with associated care maintenance and quality of life issues, are also reviewed. Pharmacologic therapy will be discussed in the subsequent chapter.

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Abbreviations

Ca2+ :

Calcium

CCK:

Cholecystokinin

CD:

Crohn’s disease

EGF:

Epidermal growth factor

GLP:

Glucagon-like peptide

H2O:

Water

IBD:

Inflammatory bowel disease

IF:

Intestinal failure

IV:

Intravenous

MCTs:

Medium chain triglycerides

Mg2+ :

Magnesium

NaCl:

Sodium chloride

NaHCO3 :

Sodium bicarbonate

ORS:

Oral rehydration solution

PN:

Parenteral nutrition

PN/IV:

Parenteral nutrition and/or intravenous

QOL:

Quality of life

SBS:

Short bowel syndrome

SCFA:

Short chain fatty acids

SI:

Small intestine

SIBO:

Small intestinal bacterial overgrowth

TPN:

Total parenteral nutrition

US:

United States

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Authors and Affiliations

  1. Department of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Renée M. Marchioni Beery D.O.

  2. Massachusetts General Hospital, Crohn’s and Colitis Center, 165 Cambridge Street, 9th floor, Boston, MA, 02114, USA

    Vijay Yajnik M.D., Ph.D.

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  1. Renée M. Marchioni Beery D.O.
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Correspondence to Vijay Yajnik M.D., Ph.D. .

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  1. Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Ashwin N. Ananthakrishnan

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Marchioni Beery, R.M., Yajnik, V. (2016). Short Bowel Syndrome: Physiologic Considerations and Nutritional Management. In: Ananthakrishnan, A. (eds) Nutritional Management of Inflammatory Bowel Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26890-3_10

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